Donald Trump tweeted that Britain's
National Health Service is "broke and not working." All too true:
expenses have forced 40% of walk-in
health centers to close, all
elective surgery in January to be cancelled, and primary
care has been decimated, it's not surprising that problems have surfaced.
It is just as predictable that the usual call for "more money" echoes
around the UK. All this is the result of economic laws that have been
completely ignored since the days of Aneurin Bevan,
the father of the UK NHS.
The first is the Law of Rationing. In short, "Everything is
rationed, either by price or by rule." I can't afford a private jet. Price
rationing limits those to people of substantial wealth, and their high price
acts as a signal in the market to balance the supply of private jets with the
market of willing buyers.
But suppose that the government declared that private jets were
free. Everyone would want one. Suddenly there would be a shortage of hangars
and runway space. And to pay for the jets, taxes on workers would rise, because
the workers who build private jets have to get paid. The unintended
consequences are mind-blowing. Ultimately, the government would have to start
limiting who could have private jets. First, they would require a pilot's
license. Then, more secure hangars would be required. Finally, you'd have to
prove that you really, really need a private jet.
Substitute "Free Health Care" for "Private
Jets" and you get the picture. Nothing is free. As the protagonist
in The Moon is a
Harsh Mistress notes,
"Gospodin," he said presently, "you used an
odd word earlier -- odd to me, I mean..."
"Oh, 'tanstaafl.' Means 'There ain't no such thing as
a free lunch.' And isn't," I added, pointing to a FREE LUNCH sign across
room, "or these drinks would cost half as much. Was reminding her that
anything free costs twice as much in long run or turns out worthless."
"An interesting philosophy."
"Not philosophy, fact. One way or other, what you get,
you pay for."
Or, as the mechanic in the Fram oil filter ad says, "You can
pay me now, or pay me later." You pay either way. Unfortunately, if you
try to be cheap by legislating "free" health care now, you'll pay
dearly later. Health care that was rationed by price will become rationed by
rules that make it less and less available.
In England, this process is reaching a tipping point. A couple of
years ago people were waiting many hours in the Emergency Department just to be
seen by a doctor. So the NHS ruled in 2004 that 95% of all patients would be
seen within four hours of arrival. In order to avoid breaking the rule,
Emergency Departments refused to allow ambulances to unload their patients
until the ED could meet the time standard. So patients were stuck in ambulances
outside the ED door, and there weren't enough ambulances left to answer calls.
Now the rule
has been scrapped. Predictably, the left-wing members of Parliament are
calling for more money. And that brings us to the second law.
The Law of Subsidy says that "When you subsidize something,
you get more of it and it gets more expensive." In England, this happened
a bit more slowly than in the U.S. It may be that the older generations of
Britons were a bit more "proper" than us Yanks, and so tended to rely
less on the dole than current generations. This slowed the growth of the NHS
but did not change the ultimate outcome.
The National Health Service was sold as a way to provide health
care to an underprivileged population. Aneurin Bevan stated that,
"The collective principle asserts that... no society
can legitimately call itself civilised if a sick person is denied medical aid
because of lack of means."
"The National Health service and the Welfare State
have come to be used as interchangeable terms, and in the mouths of some people
as terms of reproach. Why this is so it is not difficult to understand, if you
view everything from the angle of a strictly individualistic competitive
society. A free health service is pure Socialism and as such it is opposed to
the hedonism of capitalist society."
The language of his disdain for economic laws should be familiar
in tone. By calling capitalism "uncivilised" and
"hedonism," he presaged Saul Alinsky'sRules for
Radicals and its call to "Pick the target, freeze it,
personalize it, and polarize it." The truth is unimportant. Victory is all
that matters.
Bevan succeeded, but his victory is being erased by the Law of
Subsidy. What was sold as a boon to the poor has become a subsidy for
bureaucrats. The Law
of the Bureaucrat declares that while a bureaucracy may have been
created to deal with a perceived problem, the bureaucrat's Prime Directive is
to ensure that he has a job forever. And because he was appointed to solve the
problem, he's smarter than everyone else and should be paid accordingly.
Perversely, the bureaucrat can never solve the
problem, or his job would disappear. So he continues with the language that
created him, trying to sell greater and greater funding for his failed
enterprise. And when it fails more dramatically, he blames anyone but himself,
and gets rewarded with a bigger budget. Ultimately, as Margaret Thatcher
famously quipped, "The problem with liberalism is that eventually you run
out of other people's money."
The Law of Subsidy has killed the NHS. It just doesn't realize
that it is dead. But thousands of those it was created to care for are dead,
because it simply cannot fulfill its promised goals. And the U.S. is headed
down the same path. Fortunately for us, voices are starting to point out real
fixes.
I have repeatedly
pointed out that government is bad for your health. Just as with the
NHS, the U.S. population has been sold the lie that
insurance is necessary for long life. In fact, all insurance does is increase
cost, because it's a subsidy for those who provide health care. But there has
been a conspiracy
of silence over this fact. Further, the treatment of health insurance
premiums as a non-taxed "fringe benefit" makes it easier to subsidize
further. In short, Congress passes a pretty "benefit" that you
actually pay for. And it ultimately ratchets costs higher.
President Trump has done a bit to reverse the trend, but private
citizens are doing more. Medishare is
a private cost sharing program that provides care at a fraction of insurance
rates. Outpatient surgery centers such as the Surgery Center of Oklahoma operate
at lower costs because they don't have to wrestle with insurance companies. And
many physicians are now providing concierge Direct Primary Care at drastically
reduced costs.
What do these have in common? They are completely outside the
government and insurance company umbrellas. Patients see how much their care
actually costs. Providers work to be competitive in order to attract patients.
And patient satisfaction is much greater.
I spent thirty-two years on the medical staff of a major
metropolitan medical center. There was no incentive for the administration to
ever negotiate with an individual on price. Instead, it was always a deal
between the hospital and the insurance company. My medical group did the same
thing. We negotiated prices with Blue Cross, Humana, and other insurance
companies. They passed on the costs to patients via premiums, all the while
lobbying for more and more mandates on coverage.
Could there be a system more devoted to screwing the public? No
one is personally intending to cause harm to anyone else. In fact, my group
worked hard to provide high-quality care. But the incentives are there for all
to see, if they will look. The Laws of Rationing, Subsidy, and the Bureaucrat
are laws of nature. Nothing will ever repeal them. Our only hope is to stop
going down the roads to which they lead us.
http://www.americanthinker.com/articles/2018/02/single_payer_is_doomed_before_it_starts.html